Percentage of patients who undergo a procedure under anesthesia in which a permanent intraoperative anesthesia staff change occurred, who have a documented use of a checklist or protocol for the transfer of care from the responsible anesthesia practitioner to the next responsible anesthesia practitioner.

Lack of communication or miscommunication between anesthesia providers during staff change can lead to patient harm.^1,2  Organizing these staff changes using a predefined handoff checklist ensures this communication occurs, and is as accurate and efficient as possible.^3-5

Anesthesia Start to Anesthesia End

For cesarean delivery conversion cases: 5 minutes after Cesarean Delivery Start Time to Anesthesia End.

• All patients, regardless of age, who undergo a surgical, therapeutic or diagnostic procedure under anesthesia AND a permanent intraoperative in-room anesthesia staff change occurred (outgoing provider does not return within 40 minutes).

• Obstetric Non-Operative Procedures (CPT: 01958)
• Labor Epidurals (as determined by the MPOG 'Obstetric Anesthesia Type' Phenotype results 'Labor Epidural' and 'Conversion (Labor Epidural Portion)')
• Cases with no permanent shift relief (Outgoing provider returns within 40 minutes)
• Handovers between supervising anesthesiologists – those not personally performing anesthesia care in the operating room
• Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'

Documentation of intraoperative transfer of care report in the electronic anesthesia record.

Only permanent intraoperative handoffs between in-room providers will be considered for this measure. If an attending and CRNA/AA or resident is signed into a case, only the in-room provider (CRNA/AA or resident) permanent handoff events will be tracked. If only an attending is signed into the case, the attending will be responsible and measured on the handoff performed.

If more than one permanent intraoperative handoff occurs during the case, all events will be considered for determining success. If an intraoperative handoff is not documented for any handoff event, the case will be flagged. The percentage of handoffs will be calculated as number of handoffs documented as completed in the electronic anesthesia record where the denominator equals the number of permanent intraoperative handoff events. Only those providers involved in the event without a documented handoff will be attributed. 

A permanent handoff is defined as:

• Staff relief for ≥40 minutes between staff change and Anesthesia End or,
• Staff change in which the original provider is relieved and does not sign back into the case.

A staff change is defined as the in-room provider documenting sign-out and another signing in within 5 minutes before or after the sign out.

The accepted time frame for documenting the intraoperative handoff is 15 minutes before to 15 minutes after the staff change.

The key handoff elements that must be included in the transfer of care protocol or checklist include:

1. Identification of patient
2. Age
3. Gender
4. Weight
5. Allergies
6. Discussion of pertinent/attainable medical history/Preop Medications
7. Discussion of surgical/procedure course (procedure, reason for surgery, procedure performed)
8. Intraoperative anesthetic management and issue/concerns to include things such as airway, hemodynamic narcotic, sedation level and paralytic management and intravenous fluids/blood products and urine output during the procedure
9. Expectations/Plans for the early post-procedure period to include things such as the anticipated course (anticipatory guidance), complications, need for laboratory or ECG and medication administration
10. Introduction of relieving anesthesia care provider to OR team

* For labor epidurals which convert to cesarean deliveries where the procedures are combined under one case ID, 'Cesarean Delivery Start Time' is used as the 'Measure Start Time'

Not applicable

Both providers involved in the transfer of care communication (provider signing in and the provider signing out).

1. Epstein RH, Dexter F, Gratch DM, Lubarsky DA. Intraoperative Handoffs Among Anesthesia Providers Increase the Incidence of Documentation Errors for Controlled Drugs. Jt Comm J Qual Patient Saf. 2017;43(8):396-402.
2. Saager L, Hesler BD, You J, et al. Intraoperative transitions of anesthesia care and postoperative adverse outcomes. Anesthesiology. 2014;121(4):695-706.
3. Agarwala AV, Firth PG, Albrecht MA, Warren L, Musch G. An electronic checklist improves transfer and retention of critical information at intraoperative handoff of care. Anesthesia and analgesia. 2015;120(1):96-104.
4. Hall M, Robertson J, Merkel M, Aziz M, Hutchens M. A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients. Anesthesia and analgesia. 2017;125(2):477-482.
5. Jones PM, Cherry RA, Allen BN, et al. Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery. Jama. 2018;319(2):143-153.